Concomitant acute myocardial infarction and descending thoracic aorta pen-etrating ulcer

In the emergency department, early diagnosis and detection is required as delays in treatment can result in lives lost. Acute coronary syndrome (ACS) and acute aortic syndrome (AAS) are different disease entities with some similar pathophysiology and rarely occur in a single scenario. A 61-year-old female presented to the emergency room with dull, anterior chest pain of one day duration. She had a past history of Type 2 diabetes mellitus, essential hypertension and dyslipidemia. Her initial electrocardiogram (EKG) demonstrated 0.5 mm/mV ST-segment elevation in leads III and aVF and 0.5 mm/mV ST-segment depression in leads I, aVL, V4 - V6. Her chest CT scan demonstrated blood leaks through the wall but contained by the adventitia at anteromedial portion of upper descending thoracic aorta. We performed percutaneous coronary artery intervention (PCI) of right coronary artery and thoracic endovascular aneurysm repair (TEVAR) in one procedural time. It is important to exclude acute aortic syndromes before reperfusion therapy in patients presenting with AMI. And commonly one disease entity is the cause of the symptom and is given focus; however, as seen in this case, two disease entities are involved and happening concomitantly.